背景和目的:慢性非特异性下腰痛(CNLBP)持续超过12周。建议用于CNLBP的手动治疗显示出短期疗效。疼痛神经科学教育(PNE)教导患者通过解释来修改疼痛感知,隐喻,和例子,针对大脑再教育。动机性访谈(MI)增强了行为改变的动机,引导患者远离矛盾和不确定性。这些方法共同解决了CNLBP有效管理的多面性。这项研究的目的是探讨手动治疗干预联合PNE与MI的疼痛,压力痛阈值(PPT),残疾,运动恐惧症,灾难,经历CNLBP的个体的低背部功能能力。材料与方法:将60例CNLBP成人随机分为3组(每组20例)。第一组接受手动治疗和PNE合并MI(联合治疗组),第二组只接受手法治疗(手法治疗组),第三组遵循一般在家锻炼计划(对照组)。使用数字疼痛评定量表(NPRS)评估最后24小时的疼痛,使用罗兰-莫里斯残疾问卷(RMDQ)的功能能力,通过压力测量在腰椎区域的PPT,运动恐惧症的坦帕量表(TSK),用疼痛灾难量表(PCS)进行灾难化,和使用基线时的后向性能标度(BPS)的性能,在第四个星期,干预后六个月。结果:干预组与对照组在第4周测量和6个月随访中均有统计学差异,如NPRS和RMDQ得分所示,以及测试的PPTs的总值(p<0.05)。两个干预组之间也观察到差异,在两个时间点(第4周和6个月随访),联合治疗组的统计学改善更大(p<0.05)。关于第四周的TSK和PCS成绩,与对照组相比,两个干预组之间的差异具有统计学意义,以及两个干预组之间(p<0.05)。然而,在六个月的随访中,仅联合治疗组与其他两组之间存在统计学上的显着差异,联合治疗组显着改善(p<0.05)。关于BPS,在第4周,与对照组相比,两个干预组均表现出统计学上的显着差异,两个干预组之间没有任何显着差异。然而,在六个月的随访中,联合治疗组与其他两组之间存在显着差异(p<0.05),联合治疗显示出更大的改善。结论:PNE与综合MI的添加增强了手动治疗干预在所有结局指标中的积极作用。与单独应用手动治疗相比,手动治疗加PNE与整合MI的组合似乎提供了更大的改善。这些改进也持续了更长时间。这些短期和长期的积极影响可能归因于PNE与综合MI的结合,这有助于提高治疗的有效性。需要进一步的研究来研究CNLBP个体中手动治疗和合并MI的PNE的最佳剂量。
Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.